Please complete this form and then click the 'Join clixGalore Affiliate Marketing' button below.

Please Enter Your Personal or Company Details

Country:

(Page will reload on selection)

PayPal Address / Payee Name:

Individual / Company Name:

Address1:

Address2:

City Name:

State Name:

Zipcode / Postcode:

Phone:

Fax:

Contact Name:

Please provide details of the web site where you will be placing
the advertisements. If you intend to use PPC within search engines to promote Merchants please enter
"USING PPC SEARCH ENGINES" as the website URL and include the phrase "Using PPC search engines" within your website description.

Web Site URL:

http(s)://

Web Site Name:

Web Site Description:(Max 1000 CHARACTERS)

Keywords:(Max 500 CHARACTERS.Separate keywords with a comma)

Average Hits Per Week:

Average Age Of Visitors:

Categories:

Receive Emails Informing You Of New Merchants That Have Joined clixGalore

Receive Emails From Merchants To Their Affiliates

Receive Emails From Merchants Looking For New Affiliates

Please select the username and password you wish to use with your account

Email Address:(this will be your login username)

Applications that use the following free email accounts (ie) Hotmail, Yahoo, Gmail will be manually reviewed prior to approval or rejection.
Applications that use an email address that does not use the same domain entered into the web site URL field above will also be manually reviewed prior to approval or rejection.
Applications that use an email address that does use the same domain will be automatically approved.

NOTE: Sites that promote pornography, racism or any illegal activity are prohibited.
clixGalore Affiliate Marketing will be the sole arbiter as to what constitutes a
violation of these provisions and reserves the right to remove
and suspend its services to members who violate these provisions
immediately.